Accuracy, operative time, and periodontal outcomes of 3D printed guided surgical exposure versus conventional open technique for palatally impacted maxillary canines: A randomized controlled clinical trial

Title: Accuracy, operative time, and periodontal outcomes of 3D printed guided surgical exposure versus conventional open technique for palatally impacted maxillary canines: A randomized controlled clinical trial

Abstract:

Background and Objectives: Surgical exposure of palatally impacted maxillary canines is conventionally performed free-hand, often requiring extensive palatal flap elevation, which prolongs operative time, compromises moisture control during attachment bonding, and may compromise periodontal health [1]. Virtual planning combined with static navigation has recently been shown to be feasible and to shorten surgery compared with the free-hand method [1], and virtually designed, 3D-printed guides allow limited yet precise excision of the palatal mucosa over the impacted tooth [2]. This randomized controlled clinical trial aims to evaluate the accuracy, operative time, and periodontal outcomes of 3D-printed surgical guides compared with the conventional free-hand open exposure technique.
Methods: A total of 68 patients (34 per group) aged 12–30 years with unilateral or bilateral palatally impacted maxillary canines will be enrolled and randomly allocated 1:1 into two groups. The Study Group will undergo open exposure using a 3D-printed, tooth-and-mucosa-supported surgical guide designed by registering intraoral scans with CBCT data, providing a precise window osteotomy and accurate bracket/attachment positioning. The Control Group will undergo conventional free-hand open exposure. The primary outcomes will be surgical accuracy (deviation of the actual osteotomy/attachment position from the digitally planned position on superimposed postoperative CBCT) and total operative time. Secondary outcomes will include postoperative pain (VAS), periodontal parameters of the exposed canine and adjacent lateral incisor — probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and marginal bone level on CBCT — assessed at baseline and at 3 and 6 months postoperatively.
Results: the guided group demonstrate significantly lower positional deviation, shorter operative time, and superior preservation of periodontal parameters compared with the conventional group. Based on the randomized trial by Kivovics et al., computer-assisted exposure significantly reduced operative time (4 min 45.1 s ± 1 min 8.4 s vs. 7 min 22.3 s ± 56.0 s in the free-hand group), while postoperative VAS pain scores did not differ significantly between techniques [1].
Conclusions: The implementation of CAD/CAM 3D-printed surgical guides in the management of palatally impacted maxillary canines offers a predictable, minimally invasive approach that is expected to enhance surgical precision, reduce operative time, and optimize periodontal preservation.

Biography:

Tannaz Pourlak is a specialist in oral and maxillofacial surgery. She is currently working as an associated -professor at the School of Dentistry, Tabriz University of Medical Sciences. She believes that educating students and treating patients is not possible without conducting research projects, as science is dynamic. She obtained her doctorate degree in maxillofacial surgery in 2017 and after completing 5 years of residency from at Tabriz University of Medical Sciences. In addition to teaching at the university and conducting research projects, she also has a private office where she treats different patients. She is busy working as the only female maxillofacial surgeon in Tabriz city. She works in various fields of oral surgery, maxillofacial surgery, especially third molar surgery, rhinoplasty and orthognathic surgery.